Chiou Yueh-Er, Chung Chi-Hsiang, Chien Wu-Chien, Tsay Pei-Kwei, Kan Hung-Cheng, Weng Wen-Hui
Department of Nursing, College of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan.
Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114, Taiwan.
Life (Basel). 2022 Dec 16;12(12):2130. doi: 10.3390/life12122130.
The high recurrence rate has always been a problem associated with urolithiasis. This study aimed to explore the effectiveness of single interventions, combined therapies, and surgical and nonsurgical interventions. Herein, three lithotripsy procedures—extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and ureteroscopic lithotripsy (URSL)—were assessed and a retrospective cohort was selected in order to further analyze the association with several risk factors. Firstly, a population-based cohort from the Taiwan National Health Insurance Research Database (NHIRD) from 1997 to 2010 was selected. In this study, 350 lithotripsy patients who underwent re-treatment were followed up for at least six years to compare re-treatment rates, with 1400 patients without any lithotripsy treatment being used as the comparison cohort. A Cox proportional hazards regression model was applied. Our results indicate that the risk of repeat urolithiasis treatment was 1.71-fold higher in patients that received lithotripsy when compared to patients that were not treated with lithotripsy (hazard ratio (HR) 1.71; 95% confidence interval (CI) = 1.427−2.048; p < 0.001). Furthermore, a high percentage of repeated treatment was observed in the ESWL group (HR 1.60; 95% CI = 1.292−1.978; p < 0.001). Similarly, the PCNL group was also independently associated with a high chance of repeated treatment (HR 2.32; 95% CI = 1.616−3.329; p < 0.001). Furthermore, age, season, level of care, and Charlson comorbidities index (CCI) should always be taken into consideration as effect factors that are highly correlated with repeated treatment rates.
高复发率一直是与尿石症相关的一个问题。本研究旨在探讨单一干预、联合治疗以及手术和非手术干预的有效性。在此，评估了三种碎石手术——体外冲击波碎石术（ESWL）、经皮肾镜取石术（PCNL）和输尿管镜碎石术（URSL），并选择了一个回顾性队列以进一步分析与几个风险因素的关联。首先，选取了台湾国民健康保险研究数据库（NHIRD）中1997年至2010年基于人群的队列。在本研究中，对350例接受再次治疗的碎石患者进行了至少六年的随访以比较再次治疗率，将1400例未接受任何碎石治疗的患者作为对照队列。应用了Cox比例风险回归模型。我们的结果表明，与未接受碎石治疗的患者相比，接受碎石治疗的患者再次进行尿石症治疗的风险高1.71倍（风险比（HR）1.71；95%置信区间（CI）=1.427−2.048；p<0.001）。此外，在ESWL组中观察到较高比例的重复治疗（HR 1.60；95%CI =1.292−1.978；p<0.001）。同样，PCNL组也与高重复治疗几率独立相关（HR 2.32；95%CI =1.616−3.329；p<0.001）。此外，年龄、季节、护理级别和查尔森合并症指数（CCI）应始终作为与重复治疗率高度相关的影响因素加以考虑。
